Does Health Insurance Cover Ambulance Rides?

Health insurance typically covers ambulance rides when medically necessary, with potential coverage for nonemergency and postemergency services.

However, the details can vary depending on your plan and state regulations. For instance, 14 states have enacted laws to protect consumers from unexpected balance billing for ground ambulance services. California is the most recent addition, implementing legislation on January 1, 2024.

Understanding your coverage limits and network restrictions will help you navigate these costs effectively in an emergency.

Health insurance will generally cover ambulance services when using an ambulance is the safest and quickest way to transport you to a medical facility in an emergency. In some cases, health insurance plans may also extend coverage to ambulance transports in nonemergency situations, such as when a hospital cannot provide adequate care or when transitioning to specialized care facilities becomes necessary.

When using ambulance services, it is advisable to choose an in-network provider whenever possible. Opting for an in-network provider can significantly reduce costs compared to booking an ambulance outside your insurance network. However, even if you choose an in-network provider and your policy covers ambulance services, you may still be responsible for paying a copayment or co-insurance as part of your coverage.

It's also wise to be aware of potential restrictions on your policy's coverage. Typically, insurance policies cover transportation to the nearest hospital that can provide appropriate services. If your ambulance takes you to the second-closest hospital, you might be responsible for paying more of the bill.

Given that the specifics of coverage can vary widely depending on the type of insurance plan you have selected, review your summary of benefits to make informed decisions about your health care needs.

Health insurance typically covers air ambulance services in medical emergencies. Some plans may cover the medical care required during transportation, including essential equipment like oxygen or life support.

The No Surprises Act mandates that emergency air ambulance services must be billed at in-network rates, even if the provider doesn't have a contract with your insurer. This means you will be responsible for paying the deductible, co-insurance and copayment as if the air ambulance provider were in-network. However, the law does not apply to ground ambulance rides.

Medicaid covers ambulance rides for emergencies without cost-sharing for beneficiaries. However, coverage and potential cost-sharing requirements can vary by state.

Medicaid also includes coverage for nonemergency medical transports when ordered by a physician. Verify the specific coverage in your state through your state's Medicaid program or Medicaid managed care plan.

Medicare Part B covers ground and air ambulance rides in emergencies. Limited coverage for nonemergency transports is available with a physician's written order.

For emergency ambulance services, Medicare typically covers 80% of the approved amount, with the beneficiary responsible for the remaining 20% and any applicable deductibles. Review your Medicare plan's details or contact Medicare for precise coverage and potential out-of-pocket expenses.

In some specific conditions, health insurance may also cover ambulance services in case of nonemergencies, like in the below scenarios:

Inadequate Care: If the original hospital you were taken to cannot provide adequate care, your insurance may cover transport to the closest in-network hospital that can provide necessary medical care. This gives you access to the appropriate treatment without incurring additional expenses.

Transition of Care: Sometimes, health insurance plans cover ambulance transport from a short-term or acute care facility to the closest long-term acute care facility. Similarly, transport from a hospital to a rehabilitation facility when additional medical care is required may also be covered. These provisions can be essential for individuals in need of specialized care.

Fourteen states in the United States have enacted laws to protect consumers from balance billing by ground ambulance providers. California, the most recent state to enact such legislation, has implemented these laws effective January 1, 2024, ensuring that Californians with state-regulated health insurance receive protection against excessive charges from out-of-network ground ambulance providers.

These laws vary in their approaches to safeguarding consumers, from setting rates for out-of-network ground ambulance payments to explicitly prohibiting ground ambulance balance billing. The table below highlights states' differing consumer protections regulating surprise billing for various ambulance services and providers.

There are many situations where your health insurance may not cover transportation charges, such as using a taxi to reach your in-network facility, even during an emergency. We highlight these common scenarios below:

• Lack of Prior Authorization: Failure to obtain prior authorization from your insurer before scheduling an ambulance ride may lead to a lack of coverage. Insurance plans often require pre-approval for nonemergency transports to ensure the medical necessity of the trip.

• Not a Medical Necessity: If it is determined that using an ambulance is not the safest and quickest way to transport you to a medical facility, the insurance company might not cover the expenses.

• Billing and Submission Compliance: If the ambulance provider does not follow the correct billing procedures or submit the claim according to the insurer's guidelines, it could result in non-coverage.

• Use of Non-Licensed Ambulance Services: If you choose alternative transportation methods, such as a car, taxi, bus, gurney van or wheelchair van, instead of a licensed ambulance, your insurance may not cover the expenses.

• Transport to Nonqualifying Facilities: Insurance companies often do not cover ambulance rides to nonqualifying destinations, such as transportation to a home, residential facility or custodial care facility that does not meet their medical necessity criteria.

• Coverage Limits: Your insurance policy may impose coverage limits. These limits can include restrictions on the distance of transportation, the number of covered trips or the types of medical conditions that qualify for coverage.

Familiarizing yourself with these situations can help you minimize out-of-pocket costs and choose an affordable plan that meets your preferences.

The cost of an ambulance ride without insurance can vary significantly, typically ranging from a few hundred to several thousand dollars. For instance, before the passing of the legislative laws in certain states to protect against ground ambulance balance billing, such as in California, patients often received surprise bills exceeding $1,000, sometimes even surpassing $2,000, depending on the specific ambulance provider and insurer.

Several factors can impact your bill, including the location where you require the service, the distance of the trip, the type of transport (e.g., ground or air ambulance) and any medical care provided during the ride.

• Location: Ambulance costs can differ significantly from region to region. Due to variations in health care pricing and local economic factors, ambulances may be more expensive in certain areas of the country.

• Trip Distance: Many ambulance services charge based on the distance traveled. The farther the transportation, the higher the cost. This factor must be considered when assessing potential expenses.

• Transport Type: The type of ambulance used can significantly impact the cost. Ground ambulances are generally more cost-effective than air ambulances, which can be considerably more expensive, often reaching tens of thousands of dollars.

• Treatment on the Trip: In addition to the base ambulance fee, you may be charged for any medical care provided during the ambulance ride. This includes the cost of medical supplies, medications and any specialized equipment used.

• Specialized Services: The cost may increase if your condition requires specialized medical services such as advanced life support during ambulance transport.

Familiarizing yourself with these factors can help you make a plan to reduce your costs in case of an emergency.

Throughout the appeals process, remember to maintain records of all communications, including emails, letters and phone calls, with your insurance company, health care provider and any external parties involved. These may come in handy as you work on your appeal and involve other organizations.